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J Clin Pathol. 2014 Aug;67(8):661-6. doi: 10.1136/jclinpath-2014-202231. Epub 2014 May 9.

Value of antibodies to free light chains in immunoperoxidase studies of renal biopsies.

Author information

1
Department of Histopathology, Wrexham Maelor Hospital, Wrexham, UK.
2
Department of Cellular Pathology, Royal Free Hospital, London, UK.
3
Department of Histopathology, Imperial College School of Medicine, Hammersmith Hospital, London, UK.
4
UCL Division of Medicine, National Amyloidosis Centre, Royal Free Hospital, London, UK.
5
Department of Nephrology, Hawke's Bay District Health Board, Hastings, New Zealand.
6
Department of Pathology, University College London, London, UK.

Abstract

AIMS:

Because immunoglobulin abnormalities may affect the kidney, investigation of renal biopsies requires immunohistological study of light chains. A problem is that most antibodies to light chains react with whole immunoglobulins as well as free light chains, and there are generally many more whole immunoglobulins than free light chains. The usefulness of antibodies that only detected free light chains was investigated.

METHODS:

Antibodies to free light chains were used in an immunoperoxidase method on paraffin sections of 198 renal biopsies, and compared with conventional antibodies against light chains examined by immunofluorescence on 13 frozen sections and by immunoperoxidase on 46 paraffin sections.

RESULTS:

Immunofluorescence and immunoperoxidase were concordant on 10 of 13 biopsies. Immunofluorescence detected slight deposition of light chains in three biopsies not shown by immunoperoxidase, of undetermined clinical significance. Using immunoperoxidase, the free light chain antibodies were more sensitive than conventional antibodies, giving much cleaner staining and better detection of deposits in AL amyloid, light chain deposition disease and cryoglobulinaemic glomerulonephritis. The free light chain antibodies showed discordance or ambiguity between immunohistological and clinical findings in seven (4%) of 185 patients with known immunoglobulin status. These included two of 28 cases of AL amyloid that showed no light chain deposition. The method was not designed for detection of light chain restriction in neoplastic plasma or lymphoplasmacytic cells.

CONCLUSIONS:

Polyclonal antibodies to free light chains are an improvement on conventional antibodies in immunoperoxidase study of paraffin sections of renal biopsies and are useful in everyday practice.

KEYWORDS:

light chains; sensitivity and specificity

PMID:
24817705
PMCID:
PMC4112424
DOI:
10.1136/jclinpath-2014-202231
[Indexed for MEDLINE]
Free PMC Article
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